The Drug Industry’s Poison Pills

BOSTON – One does not need to spend a lifetime in the global health-care sector to appreciate that substandard or counterfeit drugs are a major public-health hazard. These bogus products have infiltrated pharmaceutical supply chains from Azerbaijan to Zambia, wrecking the most promising programs to control, manage, and eradicate deadly diseases. Yet little is being done to stop this criminal activity.

Growing up in Pakistan, I realized how vital it was for my mother, like any educated parent, to know which drugs and pharmacies could be trusted. Little has changed since then. Local pharmacists from Lahore to Lusaka continue to sell a variety of brands of the same drug at different prices; and shopkeepers are called upon to give a candid opinion of their benefits and shortcomings.

Unfortunately, the problem runs a lot deeper than a few bad drugs sold at the corner pharmacy. Around $75 billion of substandard drugs are sold annually, causing an estimated 100,000 deaths worldwide, and making many more people seriously ill. The trade in inferior drugs also undermines fragile public-health systems in poor countries. As well as killing consumers, the effects of bad drugs can be passed from parent to child, and even create new drug-resistant strains of diseases that threaten us all.

Yet the fight against substandard drugs has never been taken as seriously as other global health crises such as malaria, HIV, or maternal and infant mortality. This may be because there is no obvious solution.

But, in seeking answers, we must first acknowledge that the issue is larger than just counterfeit medicines. Many legitimate manufacturers worldwide, whether through complacency or incompetence, lack adequate quality controls. In some cases, deficient storage and refrigeration systems turn safe medicines into dangerous substances.

Unfortunately, those drug makers then take advantage of developing countries’ weak or poorly implemented legislation and corrupt officials to pass their products through local supply chains and into shops. Public ignorance or apathy means that those responsible are able to avoid prosecution.

The technical expertise and equipment needed to detect inferior products is usually beyond the financial reach of many developing countries. But there are low-cost alternatives. One approach, for example, would be to include on packaging a “scratch code” that includes a phone number for consumers to call in order to check that the batch number matches an authentic product. But, while this approach would certainly help to catch counterfeits, it would miss the substandard or degraded products made by legitimate firms, which are tested only by the consumer – and often at great cost in terms of health risks.

It is therefore imperative to develop new detection technologies that will work in poorer countries, and that complement existing systems such as bar codes. Detection technology must be capable of analyzing all forms of a drug – whether powder, pill, capsule, or syrup – and of detecting several different grades of quality, not just the junk. It must be simple, affordable, adaptable, and scalable; and it must work at all stages of distribution, whether at customs, in hospitals, or in remote villages.

But technology alone will not be enough. Regulators, hospitals, and drug-safety authorities must take the lead, rather than placing the burden on often poor and uneducated citizens who are struggling to care for loved ones.

The search for new, sustainable solutions, requires at least three initiatives. First, we must encourage innovation by offering research grants to support small initiatives or large-scale projects (like campaigns to fight HIV, malaria, and maternal mortality). Ideally, an international group would coordinate and develop all of the ideas and products, and take them from the laboratory to the field.

Second, we need to harness the creativity and commitment of young students, so that they understand the devastating impact of bad pharmaceuticals and become motivated to make a difference in people’s lives.

Third, we must make use of the media. Just as the world cries foul when an illegal shipment of ivory is uncovered, we must launch campaigns in the press, on television, and online to bring to account any trader, state official, or company caught selling or promoting low-quality drugs.

In this way, we will remind those in the industry of a fundamental premise: their most precious commodity is not a blockbuster drug, but the public’s trust. If drug makers and pharmacists cannot protect their customers’ health, they cannot protect their business.

Robert Skidelsky
on why the right economic policies cannot work without the right public expectations.

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